Provider Demographics
NPI:1427404011
Name:SIMPSON, BRANDON ANTHONY (IDC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:ANTHONY
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS GREEN BAY
Mailing Address - Street 2:LPD 20
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96666
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USS GREEN BAY
Practice Address - Street 2:LPD 20
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96666
Practice Address - Country:US
Practice Address - Phone:0808-592-0578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman